title: Patient safety climate in US hospitals: variation by management level.
abstract: BACKGROUND
  Strengthening hospital safety culture offers promise for reducing adverse events, but efforts to improve culture may not succeed if hospital managers perceive safety differently from frontline workers.
  
  
  OBJECTIVE
  To determine whether frontline workers and supervisors perceive a more negative patient safety climate (ie, surface features, reflective of the underlying safety culture) than senior managers in their institutions. To ascertain patterns of variation within management levels by professional discipline.
  
  
  METHODS
  A safety climate survey was administered from March 2004 to May 2005 in 92 US hospitals. Individual-level cross sectional comparisons related safety climate to management level. Hierarchical and hospital-fixed effects modeling tested differences in perceptions.
  
  
  METHODS
  Random sample of hospital personnel (18,361 respondents).
  
  
  METHODS
  Frequency of responses indicating absence of safety climate (percent problematic response) overall and for 8 survey dimensions.
  
  
  RESULTS
  Frontline workers' safety climate perceptions were 4.8 percentage points (1.4 times) more problematic than were senior managers', and supervisors' perceptions were 3.1 percentage points (1.25 times) more problematic than were senior managers'. Differences were consistent among 7 safety climate dimensions. Differences by management level depended on discipline: senior manager versus frontline worker discrepancies were less pronounced for physicians and more pronounced for nurses, than they were for other disciplines.
  
  
  CONCLUSIONS
  Senior managers perceived patient safety climate more positively than nonsenior managers overall and across 7 discrete safety climate domains. Patterns of variation by management level differed by professional discipline. Continuing efforts to improve patient safety should address perceptual differences, both among and within groups by management level.
authors.affiliation: Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts 02115, USA. ssinger@hsph.harvard.edu
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Singer
authors.forename: Alyson
authors.initials: A
authors.lastname: Falwell
authors.forename: David M
authors.initials: DM
authors.lastname: Gaba
authors.forename: Laurence C
authors.initials: LC
authors.lastname: Baker
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005239:Fear; D005260:Female; D006739:Hospital Administration; D006801:Humans; D008297:Male; D008875:Middle Aged; D015279:Organizational Culture; D010564:Personnel, Hospital / Q000523:psychology*; D017751:Safety Management / Q000458:organization & administration*; D014481:United States